Dry eye tests using photography

Dry eye tests using photography

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Lid action and lubrication

Upper and lower lid lubrication

The internal leading edge of the lid causes boundary friction rub on the cornea. There are meibomian glands every few millimeters to put oil the tear prism or (lacrimal lake) including meibomian oil spheres and aqueous. If this  leading edge is not lubricated it creates SPK. It can also rub across the cornea on sideward movements of the eye.  

Interpreting meibography

We are correlating structure to function. When glands are missing it is easy to tell, however some are engorged, or missing segments. Above you will see several classifications of abnormal structure of the glands. We combine them with clinically observed microsphericles in the precorneal tear film as a function test of oil production.  The clinical question is whether our treatments of heat to various means of expression revive ailing glands. Photography helps us document changes. 

Different meibography interpretations
Different meibography interpretations

Photographic meibography

Lower lid photographed with Ipad
Lower lid photographed with Ipad

The Eyephotodoc is an inexpensive way to look at morphology of the meibomian glands. With oblique diffuse lighting these glands shine through the tarsal plate allowing easy assessment.  It also allows documentation of lower lid conjunctival inflammation.  The photograph can be further enhanced by using the Apple app’s camera filters. 

Tear drainage

There is a process of nourishing tears made under the lid going past the lid margins onto the ocular surface.(unseen)  There is a concomitant drainage of tears with debris exciting the punctum. Abnormalities of drainage as seen below can cause symptoms of dry eye and is under appreciated. This eye did not have a physical obstruction.  

Disorders of the lid rubbing on cornea

Dry eyes have multiple factors necessary to cause problems. The need for lubrication increased as lid margin and tarsal conjunctiva are roughened. Hence good lubrication will alleviate much of the problem. 

Meibomian glands and function

Currently it is a new area of intense interest.  These 40 glands on the upper and lower lid are very active putting oil and meibomian lubricating spherical particles into the tear film. The easiest component to see are the floating microsphericles. Here is how we currently evaluate the morphology of the gal and. 

1. Slit lamp inspection of the orrifices for kerstinization, serration and plugs

2. The  contents can be expressed by pressure with a cotton tip. The meibum should not be extremely viscous

4. Meibography or slit lamp exam of glands. We look for drop out, proximal swelling and distal (toward conjunctiva) drop out. While a dedicated machine is best using oblique light one can see the glands. Green light, red free even enhances them more. 

Dr. Clifford Terry